Fractional CO₂ vaginal laser therapy for genitourinary syndrome of menopause in breast cancer survivors: a scoping review

Abstract

Genitourinary syndrome of menopause (GSM) is highly prevalent among breast cancer survivors (BCSs), largely due to treatment-induced hypoestrogenism. Hormonal therapies are often contraindicated, creating a need for non-hormonal options. This scoping review aimed to map and critically summarize the evidence on the efficacy and safety of vaginal CO₂ laser therapy for GSM in women with current or previous breast cancer. A scoping review was conducted in accordance with PRISMA-ScR guidelines. PubMed, Embase, Cochrane Library, Web of Science, and APA PsycInfo were searched from inception to June 2025. Randomized controlled trials and observational studies investigating vaginal CO₂ laser therapy for GSM among BCSs were included. Data were extracted on study design, laser protocols, outcomes, follow-up, and adverse events. Twenty-two study reports representing approximately 1,099 BCSs participant observations were included. Most observational studies reported within-group improvements in GSM symptoms, FSFI, VAS, and Vaginal Health Index scores. Treatment was generally well tolerated in the short term. However, study designs, populations, outcome measures, and follow-up durations were heterogeneous. The two sham-controlled randomized trials did not demonstrate a clinically meaningful benefit over sham treatment, whereas the two active-comparator randomized trials found no clear differences between CO₂ laser therapy, radiofrequency, and promestriene. Vaginal CO₂ laser therapy appears well tolerated in the short term, but current evidence remains limited. Further adequately powered sham-controlled trials with standardized outcomes and long-term follow-up are needed to establish treatment-specific efficacy and safety in BCSs with GSM.